The Hidden Culprit: Abdominal Tuberculosis Masquerading as Ovarian Cancer in a 22-Year-Old Woman

Abdominal tuberculosis (TB) is a rare extrapulmonary manifestation of TB in Europe. It may resemble ovarian cancer, especially when ascites, an adnexal mass, and elevated CA-125 levels are present. This case report aims to underline the significance of considering abdominal TB as a differential diagnosis when evaluating ascites with an adnexal mass. The presence of an adnexal mass and ascites should prompt consideration of a TB origin among the possible causes. This case highlights a significant diagnostic challenge, with delays in both diagnosis and management. The patient was evaluated across six specialities (Accident & Emergency, Acute Medicine, Gynaecology, Gynae-Oncology, Infectious Diseases, and Respiratory Medicine), illustrating the complexity and multisystem involvement that contributed to the prolonged diagnostic pathway. Diagnosis of abdominal TB can be challenging and time-consuming. Imaging and tumour markers alone are insufficient. Definitive diagnosis often requires histopathological examination and PCR testing to confirm the presence and nature of the disease.